THE NEW CARNAGE AND ITS COLLATERAL DAMAGE

I grew up in the era of "carnage on the highways" and "unsafe at any speed", referring to the risks to life and limb of travelling in motor vehicles. Now there's a new carnage - a new leading cause of accidental death in North America. 

Here's an excerpt from in interesting story published recently online at www.drugfree.org/jointogether:

Deaths caused by drugs have topped traffic-related deaths, an analysis by the Los Angeles Times concludes. The rise in drug-related deaths is due in large part to an increase in overdoses from prescription narcotics. This is the first time drugs have caused more deaths than motor vehicles since the government started tracking drug deaths in 1979

... Painkillers and anti-anxiety drugs are often involved in drug-related deaths, the article notes. These drugs are now the cause of more deaths than heroin and cocaine combined.

... prescription drugs can be dangerous because people believe they are safe, since they have been prescribed by a doctor. Younger people believe they are safer because they see their parents taking them. It doesn’t have the same stigma as using street narcotics ...

... Between 2000 and 2008, drug-related deaths more than doubled among teenagers and young adults, and more than tripled among people ages 50 to 69. The greatest number of drug-related deaths was among people in their 40s."

Do you know what drug causes more deaths in North America than prescription and illegal drugs combined? 

You guessed it - alcohol.

I work with the families of people who've become a statistic in this carnage.  They're easy to forget, but that doesn't mean they haven't been affected. More than just affected, everyone who has an emotional connection with a chemically dependent person has been traumatized.

Trauma isolates ... trauma shames and stigmatizes ... trauma degrades the victim ... trauma dehumanizes the victim ... (Trauma and Recovery, Judith Herman, p.214)

Where am I going with all this?

As depressing as the statistics of these accidental, preventable deaths are, I think of the people left behind: the walking-wounded who, in many instances, don't know they've been wounded.

For every statistic on the death of someone who loses their life using alcohol or other drugs there's at least one child, parent, spouse, lover or friend. The numbers of the affected are overwhelming.  It's hard not to feel overwhelmed at the prospects for our communities.

At least that's how it feels as someone who works in this field.



THE STAGES OF CHEMICAL DEPENDENCY

Loved-ones of a person so suffers from addiction are often mystified by how chemical dependency snuck up on their spouse, or parent, or child. They say things like, " ...the drinking hasn't always been so bad", or "he drank for years and it's just been in the last few months that it got out of control", or "she used to be the life of the party, now she sneaks around hiding booze and drinking all the time" or "my son experimented with drugs like all his friends, why did they move on with their lives and and he's out on the streets?" ... and so on.

The answer lies in the fact that the disease of addiction doesn't always explode full-blown into a person's life, but has four progressive stages.

If left untreated, the final stage ends in death - addiction is a fatal disease.

Each stage is characterised by the predominant motivation to drink or use, and by what a person hopes their relationship with alcohol or other drugs will bring them.

The name of each stage comes from this motivation:

Stage 1: Pleasure

Stage 2: Relief (from discomforts)

Stage 3: Maintenance (to feel normal)

Stage 4: Escape (to oblivion)

When a person enters the first of these four stages, they have made the transition from a casual (pre-dependent) relationship with alcohol or other drugs to a committed, pathological relationship.

Nothing illustrates this better than a real-life example. The other day I read an article about Todd Fedoruk, a professional hockey player, and his life in addiction. His story tells us what it's like to live through each of the four stages: 

Stage 1: the predominant motive is PLEASURE

     Virtually every human being enjoys a pleasant mood. That's the motivation behind even the most causal relationship with alcohol or other drugs. Generally, that's why people drink. 

      But some people experience pleasure that is so rewarding and intense that the casual relationship becomes committed - and pathological. It is the beginning of their illness, and even when the motive is pleasure, there are negative consequences. Here's what Todd Fedoruk experienced: 

He remembers being 14 or 15 years old, hanging with a group of older teens when he got drunk for the first time. A shy kid, he was suddenly the center of attention. His social fears and anxieties evaporated one sip at a time. His idea of an alcoholic was some bum under a bridge with a brown bag in his hands, not a blossoming star with his eyes on the NHL.

“What booze did for me at that age, I fell in love with it instantly,” he said. “What I felt that night stayed with me forever. I had found a new friend. And it was alcohol.”

He could have used a more pious sidekick. His drinking increased and he spent a night in jail at 19 because of a bar fight directly related to his alcohol consumption.

Stage 2: the predominant motive is RELIEF from discomforts.

    When we hear someone talk about self-medicating, they're usually referring to this stage. That doesn't mean that they are no longer motivated by pleasure - but relief has become the predominant motive to use.  

He moved on to harder partying and later nights. His drinking morphed from casual fun to an addiction. That didn’t prevent him from getting drafted. The Flyers made him a seventh-round pick in the 1997 draft.

What drinking did was halt his promotion to the NHL. He was out of control at 20 when the Flyers gave him an ultimatum: Get help or he’d be sent packing.

He did what he could to salvage his career and got clean. He checked into treatment for alcohol and chemical dependency. He was admitted for a 28-day stay, but was let out after only 17 days.

He always felt like he didn’t fit in and was socially awkward around people. In treatment, he found answers and ways to cope that didn’t involve hitting the bottle.

Stage 3: the predominant motive is MAINTENANCE of normalcy 

     This stage means that a person must maintain a certain level of alcohol or other drugs in their system - just to function in their everyday lives. There's also the fear that if they didn't, the withdrawal could be not only uncomfortable, but life-threatening.  

 …..One as a brawling hockey player who upheld a code of conduct, one as a devoted family man, and one as a relapsed drug addict who secretly prowled the streets for his next big score. There was no trigger point, no defining incident that sent his life spiralling back out of control. He simply says he lost focus on the big picture of how to maintain his sobriety.

He wanted to be the life of the party.

“I was loud, somewhat obnoxious,” he said. “It was always, let’s go, let’s keep it going. It was 6 a.m. and I was looking for people to wake up and keep going.”

Stage 4: the predominant motive is ESCAPE to oblivion.

     This is also called the terminal stage. A person may not be consciously suicidal, but everybody around them knows they just want the pain to end:

“I wanted that oblivion. That’s what I craved, that escape,” he said. “With being sober, everything is real. You’ve got to deal with (stuff).”

“I didn't want to drive anywhere because I was loaded,” he said. “I couldn't stay in the house because I was paranoid. ... 

“I knew everything was coming to an end. I didn't care about hockey anymore. I didn't care about my family. I was struck with this feeling of, how the hell did I get back here after everything I've been though? How the hell did I get back in this position again?”

Another way to understand the four stages is like this:

Stage One:  Use and Live

Stage Two:  Live to Use

Stage Three: Use to Live

Stage Four: Use to Die

 You can read the full story: http://www.globeandmail.com/ NHL enforcer Todd Fedoruk opens up about drug abuse, September 9, 2011

For more information about the stages of addiction: The Essentials of Chemical Dependency, Robert M. and Mary McAuliffe (2007)

RELATIONSHIPS AND LOSS OF SELF

Thomas Merton, the well-known American Catholic monk, wrote this in the 1960's:

Alienation begins when culture divides me against myself, puts a mask on me, gives me a role I may or may not want to play.  Alienation is complete when I become completely identified with my mask, totally satisfied with my role, and convince myself that any other identity or role is inconceivable. 

Alienation is another way of describing the experience of loss of self.

And loss of self is the best way of describing what happens to a person when they become codependent.

When a person takes on roles in order to make accommodations to someone else's behaviour, the accommodations contribute to a loss of self. My accommodations are the roles, the masks I take on to survive in a relationship, or relationships, and after awhile they become my alienated self. What I do to accommodate others becomes me - my identity.

The most common relationship that results in the loss of self is when at least one of the people (maybe several) makes accommodations to at least one of them (maybe several) who is dependent on alcohol or other drugs..

A relationship with at least one codependent and at least one dependent is called an alcoholic, or an addicted relationship. An alcoholic, or addicted, family

Some of the most tried and true ways to lose oneself in an alcoholic relationship is by making one or more of the following accommodations:

- Attempting to control the other’s alcohol and other drug use.

- Ruminating over whose fault it is, self-analysis, guilt

- Rescuing others from the dependent’s behaviour

- Resolving to do something about the problems, then backing down

- Accepting verbal, physical, emotional, or sexual abuse from loved-one

- Compromising personal moral values

- Refusing to allow oneself to express, or even feel, feelings

- Developing defences to protect oneself from the hurt, pain and guilt that surrounds the deteriorating relationship: denial, minimization, rationalization, sarcasm, etc.

- Delusion: holding onto a persistent belief, despite serious evidence to the  contrary, that the dependent will change.

- Enabling: Refusal to allow the dependent to experience the consequences of his or her behaviour.

- Physical reactions stemming from the stress and anxiety inherent in living with a dependent person: headaches, stomach aches, insomnia, depression, appetite changes, anxiety, etc.

- And so on …….. the list of possibilities may be endless.

Becoming a mature, differentiated self in relationships with others means being able to turn one's attention on oneself - to become self-aware - and to learn self-regulation of one's own emotional state and to self-soothe. When a person (or a whole family) lives under the thumb of addiction, they are very difficult skills to learn. 

And the great tragedy of living in an alcoholic family is that the loss of self, the alienation, becomes normal - that is when I become completely identified with my mask, totally satisfied with my role, and convince myself that any other identity or role is inconceivable.

The good news of course is that these are learned attitudes and behaviours - and what is learned can be unlearned. And new behaviours and attitudes can be learned - even though the temptation, as Thomas Merton said, is to 'convince myself that any other identity or role is inconceivable'. 

Not true. 

A MOTHER'S GREATEST CHALLENGE: LETTING GO

This is my first volley into a discussion that I see all the time in my work with families who are hurt by addiction. It's a difficult thing to approach because it appears to denigrate a sacred insititution: motherhood.



Before I get into it, let me acknowledge that the mother-child relationship is the most fundamental and essential of all human relationships. The primary connection between mother and child transcends all human cultures (cultures organize all other relationships in a multitude of different ways) and provides a solid relational foundation upon which a healthy, happy life can be built - or not. 

I want to be understood from the beginning that I recognize and accept that a mother's relationship with her child is, especially at the beginning, an important building-block for the child to grow up into a mature, resilient adult - or not. 

A major part of growing into a mature, resilient adult is a process called the differentiation of a self. It involves developing an awareness of one's interdependence with others, an awareness of the influence of emotion and relationships on one's behaviour - while at the same time not being at the mercy of the feelings of the moment. A person with a well-differentiated self knows they are powerless over many things, but they also know they always have a choice - either to act selflessly or in the best interests of the group, - but not in response to relationship pressures.

A person with a well-differentiated self can be emotionally close to another but retains an independent, separate identity.

A person with a well-differentiated self can be honest with onself and others, be responsible to oneself and others and is forgiving of oneself and others.

BUT ...

A person with a poor sense of self will have difficulty thinking for themselves and taking on the responsibilities of adulthood. It is very difficult to be honest, forgiving and accountable for one's behaviour when pleasing others and relying on other's moods to determine one's own mood are what determines one's own well-being.
People tend to marry people at the same level of differentiated self as they are.

If people with a poor sense of self become parents, they will tend to raise kids with a poor sense of self. 

And if a mother with a poor sense of self becomes anxious about the behaviour or safety of one of her children, she will protect and control that child - evoking the mantra - "I'm a mother ... " no matter how old the child is - well into their 30s, 40s and even 50s.

This is one of the major obstacles that prevents families from transcending the addiction of a son or daughter.

True, chemical dependency puts the addict's life at risk. People die as a direct result of drinking and using.

Knowing this, parents become over-protective and controlling, which unfortunately tends to accelerate their addicted child's downward spiral. Their inability to allow their son or daughter to experience the consequences of their behaviour all too often only makes things worse.

When someone is guaranteed to pay their rent or give them safe haven no matter what - why would an addict have the incentive to do anything but indulge their addiction?

The hardest part of the recovery journey for parents is recognizing their part in the addicted family system and stop doing it.

Detach with love is the mantra of family recovery.

Evoking the mantra - I'm a mother - is an excuse not to work on one's differentiation of a self - which would allow one's son or daughter to develop their own. (The good news is it's never too late to do so.)

Yes there are risks - but when a mother refuses to let go and let her child grow up, and that child is an addict, the risks are even greater.